SPINAL CORD INJURIES IN LOUISIANA DUE
TO FALLS FROM DEER STANDS, 1985 - 1994
DAVID W. LAWRENCE, MPH, RN,CS;
LYNN I. GIBBS, MPH;
MELVIN A. KOHN, MD
Copyright 1996, Journal of the Louisiana State Medical Society
Serious injures resulting in paralysis and death have occurred to hunters who have fallen from deer stands that were not equipped with safely restraints. Among the most serious of these are spinal cord injuries. We examined all deer stand-related spinal cord injures reported to Louisiana's Spinal Cord Injuries Registry from 1985 through 1994. During the 1985 through 1991 hunting seasons, we received reports of 28 deer stand falls resulting in permanent paralysis (an average of four each year) and 13 reports of temporary necrologic deficit. These injures led to first-year medical care charges estimated at more than $4.2 million. None of the patients in the reported cases were using a safety restraint at the time of injury. After a public information campaign to make hunters aware of the ask of using deer stands without safety belts was conducted in 1992, there were no reported spinal cord injures associated with deer stand falls for the following three years.
Serious injuries resulting in paralysis and death have occurred to hunters who have fallen from deer stands (1, 2). Most deer hunters use elevated slings or platforms called deer stands, mounted 10 to 30 feet or higher above the ground' to lessen the chance of being seen and yield an expanded field of vision. Victims of falls from these heights typically suffer multiple orthopedic and internal organ injuries, some of which are life threatening (3, 4). Among the most serious of these are spinal cord injuries (SCI).
Some deer stands are commercially manufactured, but most are constructed by the hunter. Manufactured stands range from simple nylon slings to elaborate devices that consist of an aluminum frame or platform that clamps or bolts to a tree. A hunter-constructed stand typically is a wooden platform nailed to tree limbs.
Most commercial stands come equipped with simple wide belts or harnesses. These safety devices clamp to an adjustable tether that attaches around a tree limb. The tether length is set to allow for freedom of movement while on the stand yet keep a fallen hunter within easy reach of the platform. These safety devices are also available for use with hunter-constructed stands but are rarely used.
In 1992, the Louisiana Disability Prevention Program launched a public information campaign to make hunters aware of the risks of using a deer stand without a safety device. Letters detailing these risks were mailed to hunting clubs, sporting goods stores, and hunting supply retailers across the state' requesting that they notify their customers of the need for a safety restraint with all deer stands, both commercially and privately made.
This report describes cases of SCI from deer stand falls that were reported to the Louisiana Office of Public Health, Injury Research and Prevention Section Disability Prevention Program from 1985 - 1994, that is, before and after the public information campaign was launched. These data suggest that strategies promoting deer stand safety may be useful in preventing these expensve and devastating injuries.
The Louisiana SCI Registry receives reports from acute care and rehabilitation hospitals and from neurosurgeons across Louisiana. Reporting of SCI was mandated by the legislature in 1985.
We examined all deer stand-related SCIs reported from 1985 through 1994. A deer stand-related SCI was defined as any SCI associated with an elevated platform or sling used to hunt deer from a tree. An SCI case is defined as a patient who arrives alive at an acute care hospital with an acute traumatic lesion of the neural elements in the spinal canal resulting in temporary or permanent sensory deficit, motor deficit, or bladder or bowel dysfunction(5).
Published averages for medical, continuing care, and rehabilitation charges for treatment are based upon the patient's necrologic level and completeness of cord transection or damage(6, 7, 8). We used these averages to estimate the cost of acute care, rehabilitation, and continuing care for the injured hunters.
During the 1985 through 1991 hunting seasons, 28 deer stand falls resulting in permanent paralysis were reported. Thirteen additional reports of temporary neurologic deficit were also received (Figure). Although there had been an average of four permanently disabling injuries each year prior to the public information campaign, there were no reports of deer stand-related falls for the three years following the campaign.
The 41 reported cases involved individuals whose ages ranged from 17 to 61 years with a median age of 38. Four cases were female and four were African American. Of those case reports (18) containing data on alcohol-use status, 66% were positive. None of the injured hunters was using a safety restraint.
In addition to reporting objective data, the SCI Registry reporting form allows for anecdotal narrative. At least three of the hunters lay incapacitated for more than 10 hours before being found -- one for more than a day. In two other reports, the fall was associated with the collapse of the tree stand.
These injuries led to first-year medical care charges estimated at more than $4.2 million. The continuing care for each of the 28 hunters who suffered permanent injuries will average In excess of $45,000 every year for the rest of their lives.
These costly injuries can be prevented by the use of safety belts or harnesses. Such devices are inexpensive and widely available. Indeed, after a campaign promoting the use of safety belts was initiated, no SCI from deer stand-related falls were reported for 3 years.
As of November 30, 1995, there has been one report of a deer stand fall for the 1995 season. Because of this case, we renewed our cautionary mailing to hunting clubs and hunting supply stores.
These injury rates and cost estimates under-represent the total impact of deer stand injuries. Hunters with major trauma that didn't include a documented spinal cord injury and hunters with minor injuries weren't counted as cases by the SCI Registry. Similarly, hunters who died before reaching a hospital were not included. The sensitivity of Louisiana's SCI Registry has been evaluated and is estimated to be 46%; this indicates that approximately 54% of SCI in Louisiana are not reported. The total cost of these injuries is therefore likely to be even higher than the figure reported here.
Hunting is always a potentially dangerous sport, especially when the hunter is perched high above the ground in a quiet place for long periods of time. Boredom or fatigue can lead to a hunter falling asleep. If unrestrained, this can easily result in a fall. In addition, a hunter's isolation exacerbates any injuries he might experience by causing delays in receiving medical care and hypothermia.
Alcohol is a well-known risk factor for injuries of all types (9, 10). Its consumption plays a role in these falls. Alcohol adversely affects motor coordination, decreases reaction time, and causes drowsiness a hazardous situation for an unrestrained hunter high above the ground. Although alcohol use is discouraged by sporting and hunting clubs, its use is still common.
This report suggests at least four important opportunities for patient teaching:
1. Safety restraints should be used at all times when deer stands are used.
2. Tree stands, whether hunter-constructed or commercial devices, should be tested to assure that they are correctly installed and able to withstand the weight of the hunter. Testing is especially important when using a stand for the first time in a season.
3. Hunters should avoid complete isolation, where possible. They should be cautioned to hunt in groups and to designate a time and place to meet periodically.
4. Physicians should test the blood alcohol level of seriously injured patients and counsel them about the risks of performing hazardous activities after drinking.
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2. Urquhart CK, Hawkins ML, Howdieshell TR, et al. Deer stands: a significant cause of injury and mortality. South Med J 1991; 84:686-688.
3. Mosenthal AC, Livingston DH, Elcavage J. et al. Falls: epidemiology and strategies for prevention. J Trauma 1995, 38:753-756.
4. Li L, Smialek JE. The investigation of fatal falls and jumps from heights in Maryland (1987-1992). Am J Forensic Med Pathol 1995; 15:753-756.
5. Thurman DJ, Sniezek JE, Johnson D, et al. Guidelines for Surveillance of Central Nervous System Injury. Atlanta, Ga: Centers for Disease Control and Prevention, 1995.
6. DeVivo MJ, Sniezek JE, Harrison-Felix C, et al. Violence as a cause of disability: epidemiologic considerations (presentation). Bridging Science and Program: The National Violence Prevention Conference, Des Moines, Iowa, October 22-25, 1995.
7. DeVivo MJ. The costs of spinal cord injury: a growing national dilemma. In: Apple DF Jr, Hudson LM (editors). Spinal Cord Injury: the model. Atlanta, Ga: Georgia Regional Spinal Cord Injury System, 1990:109-113
8. Price C, Makintubee S. Herndon W. et al. Epidemiology of traumatic spinal cord injury and acute hospitalization and rehabilitation charges for spinal cord injuries in Oklahoma, 1988-1990. Am J Epidemiol 1994, 139:37-47.
9. US Public Health Service. Eighth Special Report to the US Congress on Alcohol and Health (#94-3699). Washington, DC: National Institutes of Health, 1994
10. Wailer JA. Non-highway injury fatalities. I. The roles of alcohol and problem drinking, drugs, and medical impairment. J Chron Dis 1972; 25:33-45.
Ms Gina Liggett was responsible for gathering the SCI surveillance data from 1988 - 1990 and Ms Rana Bayakly from 1992-1993.
This project was funded in part by grant #U59 CCU603362 from the Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Disabilities Prevention Program, and with technical support from the CDC, National Center for Injury Prevention and Control, Division of Acute Care, Rehabilitation Research, and Disability Prevention.
Copyright 1996, Journal of the Louisiana State Medical Society